Provider Demographics
NPI:1558025312
Name:KAMOGA, AISHA NAIGA (NP)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:NAIGA
Last Name:KAMOGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HIGH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2662
Mailing Address - Country:US
Mailing Address - Phone:978-685-2460
Mailing Address - Fax:
Practice Address - Street 1:47 HIGH ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-2662
Practice Address - Country:US
Practice Address - Phone:978-685-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG09210191363LA2200X
MARN2288782363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty